Personality Disorder

“Shayan is a shy boy”, “Anandi is very outgoing and jolly”, “Mr Gupta is suspicious of everyone”, “Mrs Banerjee gets upset over very minor things”. We tend to attach these titles of someone being shy, suspicious, dramatic, outgoing and many more, to people, under the pretence of their personality. What even is this personality that we blame everything on? Personality is an individual’s characteristic way of thinking, feeling and behaving. Personality is relatively stable and is influenced by many factors like genetics, environment, personal experiences etc. When personality factors interfere with the individual’s social, occupational or educational lives and cause disruption in the daily lives of the individual, they are characterised as personality disorders.

A personality disorder is a persistent pattern of emotions, cognitions and behaviour that causes severe emotional distress to the individual in their personal and professional life. Individuals with Personality Disorders may experience emotional distress that may cause problems for the individuals and also for those around. Individuals with personality disorders usually tend to have a pattern of thinking, feeling and behaving that deviates from the cultural norms and persist for a considerable time. DSM-5 has characterized 10 personality disorders that have been classified into 3 clusters based on their resemblance.

• Cluster A disorders are characterized by odd and eccentric ways of thinking and behaving.
• Cluster B disorders are characterized by dramatic, emotional and erratic thinking and behaviours.
• Cluster C disorders are characterised by anxious, fearful patterns of thinking and behaving.

Personality disorders affect at least 2 of these areas: thinking about oneself and others, responding emotionally, relating to others, controlling others.

Cluster A Personality Disorders

This cluster of disorders includes paranoid, schizoid and schizotypal personality disorders, which all have symptoms that are a common feature of schizophrenia.

1. Paranoid Personality Disorder: This is a pattern of being excessively suspicious and mistrustful of others without any justification. Individuals suffering from this disorder assume that others are out to harm them or deceive them and hence they cannot trust others. Even in events that people may not otherwise find deceptive or harmful, individuals with Paranoid Personality Disorder may find them suspicious. They suspect the loyalty of others and hence will unusually avoid confiding in them. They will usually get extremely angry at perceived insults and hold grudges for a long time. They may also be extremely suspicious of the loyalty of their partners and question their fidelity.
2. Schizoid Personality Disorder: Individuals with this personality disorder tend to detach themselves from any social relations and express little to no emotions. The term ‘schizoid’ describes the tendency to remove oneself from society and turn inward. They do not enjoy relations with others, neither romantic nor platonic. Hence, they may appear cold and detached and are not phased by praise or criticism by others.
3. Schizotypal Personality Disorder: Individuals with this type of personality disorders are typically socially isolated and behave in unusual ways, are typically very suspicious of others and have peculiar and odd beliefs. This personality disorder is on a continuum like schizophrenia without experience of the positive symptoms. These individuals are often considered bizarre by the members of society as they tend to dress, think and behave in eccentric ways. They may have odd perceptual experiences like hearing voices. Another peculiar characteristic of individuals with this disorder is that they have ‘magical thinking’ i.e believing one can influence people and events with their thoughts. They often have beliefs about religious and spiritual themes and also are reluctant to form any social relations. They are indifferent, inappropriate and suspicious about others and have similarly inappropriate and flat emotions.

Cluster B Personality Disorders

Anti-social, borderline, histrionic and narcissistic personality disorders are classified under this cluster which is characterized by dramatic, emotional and erratic ways of thinking and behaving.

1. Antisocial Personality Disorder: This disorder is characterized by a pattern of entirely disregarding social norms and violating the rights of others. They perform actions that would be found unacceptable by others, behave irresponsibly, impulsively and tend to be deceitful. They often lack empathy, feelings of guilt or remorse. They are also described as being aggressive to achieve their ends and may do anything to achieve their goals. Substance abuse is extremely common in these individuals and they have frequent troubles with law enforcement.
2. Borderline Personality Disorder: Individuals with this personality disorder experience intense emotions, instability in personal relationships and usually have a poor self-image. It is one of the most common types of personality disorders. They often have turbulent relations, fear abandonment but lack control over their emotions and may even commit suicide. Individuals with this disorder often experience intense emotions ranging from depression to aggression in a short period. These individuals tend to be impulsive, often extending to being sexually promiscuous, binge-eating, drug abuse and self-injuries.
3. Histrionic Personality Disorder: Individuals with this type of disorder are extremely dramatic, almost like they are acting which is the etymological meaning of the word ‘histrionic’ (theatrical). They express their emotions in exaggerated ways, are self-centred, vain and constantly desire to be the centre of attention. They are concerned about their looks, dress and behave seductively and seek reassurance. They are easily influenced by others and assume relations to be closer than they are. They view the world as black and white.
4. Narcissistic Personality Disorder: This disorder reflects a pattern of unreasonable self-importance and preoccupation with oneself to an extent where one has no sense of sensitivity and compassion for others. They have a grandiose sense of self, exaggerated feelings and a sense of entitlement. They believe that they are special, possess great power, brilliance or beauty and should associate themselves with people of high status. They may even exploit others to achieve their goals and due to their preoccupation with themselves, they can be arrogant, haughty and lacking in empathy.

Cluster C Personality Disorders

Individuals with this type of personality disorder share common features with anxiety disorders. Avoidant, dependent and obsessive-compulsive personality disorders are classified under this cluster.

1. Avoidant Personality Disorder: Individuals suffering from this disorder are extremely sensitive to the opinions of others and even though they want to have social relations, their anxiety leads them to avoid others. They tend to have low self-esteem i.e feel very inadequate, inferior or unattractive and have a constant fear of rejection. They do everything in their power to avoid interpersonal contact due to their persistent social inhibition. They feel extremely shy around people and feel that they will be embarrassing, ridiculed by others and inferior to others.
2. Dependent Personality Disorder: Those suffering from this disorder are dependent on others to make ordinary decisions and feel a need to be taken care of. They tend to be clingy, timid and submissive to others. They often feel inadequate and have extremely low self-confidence. Hence, they tend to conform to others easily and face difficulty disagreeing with others. They tend to tolerate abuse even if other options are available. They feel a need to start a new relationship as soon as an older one ends.
3. Obsessive-Compulsive Personality Disorder: People who have OCPD, are characterized by a fixation to do things in “just the right way”. They have a preoccupation with orderliness, rules, control and are extremely perfectionistic. This need for perfection results in distress when things are not done how they expect. They desire control over people and activities and have an inability to delegate tasks. They are extremely rigid and stubborn about their ideas, morals and ethics. They tend to ignore their social relations or any leisure activities over their commitment to work. They are miserly spenders and money is viewed as something to be hoarded for emergencies. (Note: This is not the same as Obsessive-Compulsive disorder)

Research suggests that there are multiple factors that could lead to the development of personality disorders. Historically, it was believed that individuals with personality disorders are lazy or horrible and evil but with growing research, such prejudices are slowly being debunked. Personality disorders originate in early childhood and genetic and environmental factors have a fundamental influence on their development. They are not a direct reflection of bad parenting or abusive environment but involve an interaction of genetically fixed temperament and negative environmental factors. Imbalance of neurotransmitters like serotonin, dopamine, norepinephrine that regulate mood, suicidality, impulsivity, empathy or the lack of empathy, aggression is one of the causes of personality disorders. Genetic studies on personality disorders are still quite low and identification of specific genes that may increase the risk of an individual developing one may be extremely useful.

The environment and social conditions that one may have grown up in and the nurturing that one may have experienced is very important for how an individual’s personality develops. An unstable, chaotic and abusive family environment, lack of support from caregivers, bullying in schools or any other traumatic experiences in an educational or professional environment, poverty or drastic changes in socio-economic conditions can be some of the factors that could lead to the development of a personality disorder. Emotional and physical abuse, major accidents or tragic incidents, feelings of neglect, invalidation and lack of support during childhood may also be some of the causal factors. In a study conducted on 793 mothers and children, researchers have found that children who have experienced verbal abuse were three times more likely to have borderline, narcissistic, obsessive-compulsive or paranoid disorders in adulthood.

There are a number of treatment options for personality disorders based on one’s particular disorder and the severity of the symptoms. Psychotherapy, pharmacotherapy or the integration of both are typically the most viable options. There are no specific drugs for the treatment of personality disorders but depending upon the symptoms of the disorder, individuals may be prescribed antidepressants, antipsychotics or mood stabilizers. If someone you know has a personality disorder, it might be very difficult for them to maintain healthy relations with others. Patience is a virtue while interacting with them. When talking to them, you may experience that they may be aggressive, inappropriate, overly sensitive at times and it might be very difficult for you to acknowledge and understand their emotions. Being compassionate and non-judgemental is typically advised to those around. Personality Disorders are a part of the individual and it does not define them. Even if an individual has a particular disorder, that does not mean that they lack intelligence, likeability, creativity etc. Educating yourself about personality disorders is always advised.

Conclusion

Diagnosis of Personality Disorders is complicated. There are many social contexts that can affect diagnosis and also treatment. Along with that the name ‘personality disorder’ can itself be very stigmatising. There needs to be increasing awareness about the disorder and realise that personality disorders are not a choice. An individual is not just being lazy or negative or weird. It can be a serious condition that needs treatment from a professional and must be treated with empathy by society. An open dialogue about personality disorders is important. Individuals like Steve Jobs, Angelina Jolie, Megan Fox have openly spoken about their struggles with the disorder. Movies like Tamasha, Silver Linings Playbook, Girl Interrupted, successfully depict characters with personality disorders. Popular culture, formal education and support group need to work in tandem to reduce the stigma attached to personality disorders and mental illnesses.

References

American Psychological Association. (n.d.). What causes personality disorders? American Psychological Association. https://www.apa.org/topics/personality-disorders/causes.

Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal psychology: an integrative approach. Nelson Education Ltd.

Ma, G., Fan, H., Shen, C., & Wang, W. (2016, June). Genetic and Neuroimaging Features of Personality Disorders: State of the Art. Neuroscience bulletin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563771/.

Mayo Foundation for Medical Education and Research. (2016, September 23). Personality disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/personality-disorders/diagnosis-treatment/drc-20354468.

Shea, Tracie & Pilkonis, Paul & Beckham, E. & Collins, Joseph & Elkin, I & Sotsky, S & Docherty, John. (1990). Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program. The American journal of psychiatry. 147. 711-8. 10.1176/ajp.147.6.711.

What are personality disorders? (n.d.). https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders.

What are Personality Disorders? What Are Personality Disorders? (n.d.). https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders.

This article on 'Personality Disorder' has been contributed by Smruti Pusalkar, who is a Psychology student from Fergusson College. She is part of the Global Internship Research Program (GIRP), which is under the leadership and guidance of Anil Thomas. GIRP is an Umang Foundation Trust initiative to encourage young adults across our globe to showcase their research skills in psychology and to present it in creative content expression.

Smruti wishes to develop herself to be a more patient listener and a sharp observer to understand the happenings of the world and grow increasingly empathetic. She is passionate about mental health and well being and plans to pursue a career in this field. She is extremely curious about psychology and wants to spread awareness about mental health problems to help those in need.

Anil is an internationally certified NLP Master Practitioner and Gestalt Therapist. He has conducted NLP Training in Mumbai, and across 6 other countries. The NLP practitioner course is conducted twice every year. To get your NLP certification